2020-08-04T14:18:05-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 MARC PENNER PRESIDENT/CEO 3036805000 2020-08-04 1 KURT BENNION CPA P01469618 4252506100 2020-08-04 67.137.57.251 2020-08-04 11:36:25 PD P 48BB772327C0B50C3FF11C9D32DE9CCE547AD9E0 16B8C8A2288CEE750E5B137A18C18C08FA399435 2019 2020-11-06 18:47:13Z SHALOM CARES MARC PENNER 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 15228456 0 X WWW.SHALOMPARK.ORG X 1984 CO CREATING A JOYFUL COMMUNITY WHERE HONOR AND BELONGING FLOURISH. 17 16 270 150 0 0 9427314 780553 13433948 14245235 110846 -10450 2250 133419 22974358 15148757 3747 672146 0 0 8362333 8291295 0 0 136557 6137736 6817921 14503816 15781362 8470542 -632605 11204739 10695212 2671878 2794956 8532861 7900256 X CREATING A JOYFUL COMMUNITY WHERE HONOR AND BELONGING FLOURISH. SHALOM PARK, AN EDEN ALTERNATIVE MILESTONE II ORGANIZATION, OPERATES A NURSING HOME FOR THE AGED. IT PROVIDES HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A MULTI-LEVEL SKILLED NURSING FACILITY. 0 0 13928639 672146 14245235 SHALOM PARK OPERATES A NURSING HOME. DURING 2019, THE ORGANIZATION PROVIDED CARE FOR 244 ELDERS. 13928639 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 61 0 270 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 17 16 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X MARC PENNER 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 ANDY HEINS CHAIR 10.00 1.00 X X 0 0 0 BRUCE BENDELL VICE CHAIR & DIRECTOR 5.00 1.00 X X 0 0 0 MICHAEL STREAR PAST CHAIR & VICE CHAIR 5.00 1.00 X X 0 0 0 NEIL OBERFELD TREASURER 5.00 0.00 X X 0 0 0 ELISA ROBYN SECRETARY 5.00 1.00 X X 0 0 0 LISA COOK DIRECTOR 1.00 1.00 X 0 0 0 ROBIN CHOTIN DIRECTOR 1.00 0.00 X 0 0 0 KEN FEILER DIRECTOR (THROUGH MARCH 2019) 1.00 0.00 X 0 0 0 JAN FISHER DIRECTOR 1.00 0.00 X 0 0 0 SUSY GRAZI DIRECTOR 1.00 0.00 X 0 0 0 MARC LEVINE DIRECTOR 1.00 0.00 X 0 0 0 ANDY MILLER DIRECTOR 1.00 0.00 X 0 0 0 JAY MOSKOWITZ DIRECTOR 1.00 0.00 X 0 0 0 STUART PACK DIRECTOR 1.00 0.00 X 0 0 0 MELINDA QUIAT DIRECTOR 1.00 0.00 X 0 0 0 JARED SEIDENBERG DIRECTOR 1.00 0.00 X 0 0 0 GARY YOURTZ DIRECTOR (THROUGH JANUARY 2019) 1.00 1.00 X 0 0 0 SAM ZAITZ DIRECTOR 1.00 0.00 X 0 0 0 MARC PENNER PRESIDENT/CEO 26.00 14.00 X X 308863 0 21694 RUTH MINNEMA DIRECTOR OF NURSING 40.00 0.00 X 149472 0 9637 MINDY MOSCOWITZ NURSING HOME ADMINISTRATOR 40.00 0.00 X 125878 0 13907 DENISE BILYEU DIRECTOR OF HUMAN RESOURCES 40.00 0.00 X 105673 0 9537 689886 0 54775 4 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 2075398 HAYNES MECHANICAL SYSTEMS 5700 S QUEBEC ST 210 GREENWOOD VILLAGE CO 80111 MECH. MAINTENANCE & UPGRADES 1275650 PREMERE REHAB LLC 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 466554 PLANTE & MORAN 8181 E TUFTS AVENUE SUITE 600 DENVER CO 80237 IT CONSULTING & SERVICES 227078 MERIT ELECTRIC 2590 MIDPOINT DRIVE FORT COLLINS CO 80525 ELECTRIC PROJECTS & REPAIRS 115809 6 416133 53435 310985 780553 RESIDENT FEES 623000 14145117 14145117 ANCILLARY SERVICES 623000 100118 100118 14245235 10450 -10450 -10450 -10450 29750 416133 69249 -39499 -39499 MISCELLANEOUS INCOME 900099 172918 172918 172918 15148757 14245235 0 122969 X 672146 672146 330557 330557 6909257 6349594 472810 86853 482627 449188 27926 5513 568854 510187 52800 5867 11463 11463 27206 27206 2480484 2360158 120215 111 74376 31151 39681 3544 133140 106512 13314 13314 162587 87323 67738 7526 522915 414748 106502 1665 85620 35932 46173 3515 108025 86420 21605 1123361 923302 200059 342558 293586 46434 2538 PROGRAM SUPPLIES 808453 739534 63480 5439 FOOD 562277 562277 REPAIRS AND MAINTENANCE 235956 193814 42142 OTHER EXPENSES 109632 82899 26061 672 29868 29868 15781362 13928639 1716166 136557 1060343 729595 22657 10610 906074 937661 174705 258852 25177249 16442809 8695743 8734440 345217 24054 11204739 10695212 1558255 1021058 26700 3100 31787 24054 1055136 1746744 2671878 2794956 X 8532861 7900256 8532861 7900256 11204739 10695212 -632605 0 X 0 1 X 1 0 X 9427314 780553 10207867 14521319 14158601 13162703 13433948 14245235 69521806 14521319 14158601 13162703 22861262 15025788 79729673 0 0 0 79729673 846 846 846 846 4541 19298 10498 70452 202668 307457 14525860 14177899 13173201 22932560 15228456 80037976 0.99610 0.99860 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING EVENT REVENUES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2951498 90000 277220 3318718 2898466 249998 -196966 2951498 2878912 318110 298556 2898466 2767682 125 156417 45312 2878912 2880924 400 -64937 48705 2767682 0.00000 0.74150 0.25850 1 1 1 2561563 2561563 16649454 13251499 3397955 1730614 1651873 78741 4113450 1539437 2574013 122168 122168 8734440 X 15159207 10450 10450 15148757 0 15148757 15144392 10450 10450 15133942 647420 647420 15781362 PART IV, LINE 2B: SHALOM PARK HOLDS RESIDENT FUNDS IN TRUST FOR THEIR SECURITY. RESIDENTS MAY ACCESS THEIR FUNDS DURING NORMAL BUSINESS HOURS BY MAKING A REQUEST AT THE BUSINESS OFFICE. THE FUNDS ARE HELD IN A SEPARATE INTEREST-BEARING ACCOUNT. THE INTEREST IS CREDITED TO THE RESIDENTS' RESPECTIVE ACCOUNTS. PART V, LINE 4: BETH ISRAEL FOUNDATION FOR THE AGED, A RELATED ORGANIZATION, HOLDS ASSETS IN ENDOWMENT FUNDS. THE ENDOWMENTS CONSIST OF VARIOUS INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. PART X, LINE 2: SHALOM PARK IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION FOR STATE LAW. HOWEVER, SHALOM PARK IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 10,450. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 10,450. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS TO RELATED ORGANIZATIONS 647,420. ANNUAL DINNER 445883 416133 29750 7344 27760 12000 22145 445883 416133 29750 7344 27760 12000 22145 69249 -39499 1 BETH ISRAEL FOUNDATION FOR THE AGED 14800 EAST BELLEVIEW DRIVE AURORA CO 80015 742195249 501(C)(3) 647420 GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: THE ONLY SIGNIFICANT GRANT WAS A TRANSFER TO A RELATED ORGANIZATION. PROPER USE OF THE FUNDS WAS ENSURED THROUGH COMMON BOARD MANAGEMENT OVERSIGHT BETWEEN THE TWO ORGANIZATIONS. X X X 0 0 0 0 0 0 0 1 0 MARC PENNER PRESIDENT/CEO 299584 0 9279 0 0 0 0 0 21694 0 330557 0 0 0 RUTH MINNEMA DIRECTOR OF NURSING 143972 0 5500 0 0 0 0 0 9637 0 159109 0 0 0 PART I, LINE 7 THE MANAGEMENT TEAM RECEIVES HOLIDAY BONUSES THAT ARE DETERMINED AND APPROVED BY THE CEO AND THE BOARD'S FINANCE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CURRENT OFFICERS, THE PAST CHAIR(S) AND SUCH OTHER MEMBERS AS ARE APPOINTED BY THE CHAIR. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF AND IN PLACE OF THE BOARD BETWEEN REGULAR MEETINGS OF THE BOARD WHEN REASONABLY NECESSARY TO FULFILL THE PURPOSES AND DUTIES OF THE BOARD, AS DETERMINED BY THE CHAIR, AND IS RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD OF TRUSTEES AND FOR SUCH OTHER POWERS AS THE BOARD FROM TIME TO TIME MAY PRESCRIBE. ACTIONS OF THE EXECUTIVE COMMITTEE MAY BE OVERRULED OR AMENDED BY LATER ACTION OF THE BOARD, BUT ANY ACTION PROPERLY TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE BINDING UPON THE ORGANIZATION UNTIL SUCH LATER ACTION OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 SAM ZAITZ AND LISA COOK HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 8B THE FINANCE COMMITTEE AND EXECUTIVE COMMITTEE DO NOT KEEP MINUTES OF THEIR MEETINGS. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND CEO REVIEWED THE FORM 990, AFTER WHICH THE FINANCE COMMITTEE REVIEWED AND APPROVED THE FORM 990. THE RETURN WAS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO IT BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL AFFIRMATION SIGNED BY EACH TRUSTEE. THE ORGANIZATION MONITORS COMPLIANCE WITH THE POLICY DURING THE YEAR BY INQUIRING AT ITS BOARD MEETINGS WHETHER ANY CONFLICTS OF INTEREST HAVE ARISEN SINCE THE ANNUAL AFFIRMATION WAS SIGNED. AN INDIVIDUAL WITH A CONFLICT MAY NOT VOTE ON ANY MATTER THAT MAY INVOLVE THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIR OF THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE ACTS AS THE COMPENSATION COMMITTEE FOR THE BOARD. THE COMPENSATION COMMITTEE CONSIDERS SEVERAL FACTORS, SUCH AS THE COMPLEXITY AND DIVERSITY OF RESPONSIBILITIES OF THE CEO'S POSITION (REGULATORY, FINANCIAL, OPERATIONS, QUALITY, COMMUNITY RELATIONS, FOUNDATION DEVELOPMENT, ETC.), SOCIAL SECURITY ADMINISTRATION COST OF LIVING ADJUSTMENT, THE ASSOCIATION OF JEWISH AGING SERVICE COMPENSATION SURVEY, AND THE CONTINUOUS EMPLOYMENT AGREEMENT BETWEEN THE ORGANIZATION AND THE CEO. BASED UPON THESE FACTORS, A MUTALLY AGREEABLE COMPENSATION AMOUNT IS DETERMINED BY THE COMPENSATION COMMITTEE AND THE CEO. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF THE PROCESS THROUGH WHICH THE COMPENSATION AMOUNT WAS SET. THIS COMPENSATION-SETTING PROCESS IS DONE ON AN ANNUAL BASIS. ON AN ANNUAL BASIS, 360 DEGREE FEEDBACK IS ALSO CONSIDERED IN COMPENSATION-SETTING PROCESS. THE ORGANIZATION DOES NOT HAVE ANY OTHER OFFICERS OR KEY EMPLOYEES; HOWEVER, IT DOES HAVE A PROCESS TO DETERMINE REASONABLE COMPENSATION FOR ITS EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 2,360,158. MANAGEMENT AND GENERAL EXPENSES 120,215. FUNDRAISING EXPENSES 111. TOTAL EXPENSES 2,480,484. BETH ISRAEL FOUNDATION FOR THE AGED 14800 E BELLEVIEW DRIVE AURORA CO 80015 742195249 FUNDRAISING TO SUPPORT SHALOM PARK CO 501(C)(3) LINE 7 SHALOM PARK 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 BETH ISRAEL FOUNDATION FOR THE AGED C 53435 CASH BETH ISRAEL FOUNDATION FOR THE AGED B 647420 CASH